09.22.06 - Issue # 237 Forward This Newsletter To A Colleague
Progressive Discipline
Periodontal Probing

Let Poor Performers Dismiss Themselves
by Sally McKenzie CEO
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You try to be fair, so you tell yourself, “Ellen was late from time to time when she had young children, so I need to be more tolerant of Tara’s situation as well.” You try to be understanding, so you make excuses, “Sometimes personal issues just can’t be avoided in the workplace.” You try to look the other way, “Oh she really wasn’t that late, was she?” You try to maintain your composure, “Count to 10, breathe deeply, focus on the spot on the wall, walk away.” Until one day, you simply can’t “try” anymore. Furious, disgusted, beside yourself with anger, you finally lose it. “YOU’RE FIRED!”  There! You did it! You feel better for a split second and then you wonder just exactly what kind of a Pandora’s Box did you just unlatch.

I recommend you save yourself the stress and let employees fire themselves. Yes, you read that correctly – fire themselves. It’s called progressive discipline and employees are in on it from the beginning.

Ideally you’ll never get to that point because you’ve taken steps to ensure you hired the right people for your practice and you are helping them succeed. For example, you provide the proper tools and necessary training. You have clear practice policies in place, as well as clearly defined disciplinary procedures. In addition, you conduct and have on file regular performance reviews in which you evaluate the employee’s performance in key areas such as:

  • their ability to follow instructions
  • their consistency in following office policies and procedures
  • their willingness to help others and cooperate with the team
  • the incidents of errors in their work
  • their initiative, commitment, and innovation in carrying out their
    responsibilities and improving work flow
  • their work ethics, their attitude, and their individual productivity

Unfortunately, the working world is less than ideal, and the time to prepare for disciplinary action is not when you’re at the end of your rope and ready to send the employee packing.

Unless the employee’s behavior is so egregious that you are forced to take immediate action, the team member should be given the opportunity to improve their performance over a 60-90 day period. But don’t just call them aside and encourage them to try a little harder. You must explain to the employee verbally and in writing the specific issues that are not satisfactory and document what specific activities need to change in the employee’s performance. You and the employee must have an agreement on what she/he needs to do to improve performance. That agreement must be in writing, signed by both doctor and employee and placed in the employee’s file. Monitor the employee’s progress and give regular feedback and document every single step in the process.

In addition, if a team member violates a practice policy, document the incident with an “Employee Warning Notice” or similar document. The warning notice states specifically the type of violation committed. It also includes an area for the employee to acknowledge or deny the incident and provide her/his version of what transpired. The notice also should specifically state the type of disciplinary action that the practice will take – warning, suspension, termination, or other. In addition, it prescribes what the consequences are should the incident happen again. And, finally, it includes a signature line where the employee signs, confirming that they fully understand the notice, it’s purpose, and the repercussions.

With progressive discipline, the penalties become stronger if the employee misconduct or poor performance is repeated. For example, it may start with an oral warning, proceed to a written warning, it may go as far as suspension, and ultimately termination.

When employees see the documentation, when they understand the policies, they cannot deny that they are responsible for their actions and the consequences. It isn’t the dentist’s decision to terminate the employee, rather it’s the employee’s choice to fail to correct the problem.

Too often dentists would rather ignore the concern than deal with problem employees and disciplinary troubles. But left unaddressed these personnel issues can crush a team and wreak serious havoc on a practice. Fortunately, in today’s growing dental marketplace more support services are emerging to help dentists address the many management issues that are often a troubling distraction from what doctors really want to be doing – the dentistry.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click Here.

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Leaders Don’t Settle…
Go for what you want !

Dr. Nancy Haller, Ph.D.
Dentist Coach
McKenzie Management
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If you are reading this article, it’s an indication that you’re doing OK. You’re a dentist, or employed in a dental practice. You probably make a decent income. Overall you have a nice life. Basically you’ve got what you need. If that’s enough for you, stop reading right now.

My hunch is that over the years, you’ve raised the bar on what you want. In college or even in dental school you may have settled for a small apartment, a cheap car, maybe you slept on a sofa bed and watched a 10 inch black and white TV. It’s unlikely that those things would satisfy you now.

So why are you now settling for a good job rather than an exciting career?

The difference between getting what you need and achieving the life you want is leadership skills. By investing in yourself, you move closer to the fulfillment of your financial and professional desires. Leadership enables you to stand out from the pack. It requires courage. Displaying authenticity. Coaching and developing your staff for maximum performance. Demonstrating ethics and integrity in business.

If you are to achieve the success you seek, here are some of the leadership skills you will need.

  • Self awareness is the foundation of leadership. This doesn’t mean that you need to get into Freudian psychoanalysis, but the more you know about what makes you tick, the more effective you will be at managing yourself. Get the leadership mirror out and discover your strengths and areas of developmental need.
  • Interpersonal Competencies
    Leaders must be adept at handling all sorts of personalities and the interactions between people. These are complex and sometimes difficult, but by learning basic skills like active listening and conflict resolution you put yourself in a better position to manage others effectively.
  • Integrity
    Leadership success is built on honesty. Despite the current trends in corporate America, practicing with strong ethics is the only route to long term success.
  • Flexibility and Creativity
    Research done by The Center for Creative Leadership has shown that one of the biggest de-railers for leaders is the inability to adapt to changing situations. You never quite know what's going to happen when lots of egos, ambitions and agendas collide. That calls for the ability to turn on a dime, to come up with new solutions when necessary – or - to be able to discard ideas when they aren’t working. If you are a planful person, that’s great. However, it’s important that your plans have contingencies. Learn strategies to calm and relax yourself when the unexpected happens.
  • Tough Love
    Ultimately, leadership is about achieving real, bottom-line results. Leaders need to confront tough issues, to hold people accountable and to demand tangible outcomes. Develop your ability to communicate your expectations about job performance to your staff. Then give them timely feedback so they will know if they are track or need to realign themselves with the standards you have established.

In the beginning of this article, I invited you to stop reading if you were satisfied with the status quo. The fact that you’re still reading tells me (and YOU) that you want more. If you are a leader by default, step up to the plate and start taking an active role in developing your skills. Invest in yourself. Read. Get a coach. It will pay off in the end!

The potential to become a better leader is well within your capability! Dr. Haller is available for dental leadership coaching and development. Contact her at coach@mckenziemgmt.com to find out if you would benefit from one of our leadership programs.

Interested in having Nancy speak to your dental society or study club? Click Here.

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Probing and Your Patients

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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There are many systems in the dental practice, but how many people have actually thought of probing as another system in the dental practice? What is a system? According to the American Heritage Dictionary a system is, “A group of interacting elements functioning as a whole.” There are many offices that probe their patients once a year. The hygienist probes and writes down her own probings. Many professionals do not explain exactly what the probings mean, or do not probe at all.

Why do many practices not follow through with this protocol? Their mind set has been prophylaxis based instead of a diagnosis based hygiene department. Clean first, evaluate later. Barriers are erected for you and your staff that prevents you from helping your patients maximize their health. Encourage and empower your staff to achieve the desired results.

  • Establish a game plan
  • Be prepared to answer questions the patient is likely to ask.
  • Understand the disease
  • Understand insurance codes
  • Establish proper fees in order to create the value of the service you are providing.
  • Do complete, thorough periodontal evaluations

In order to truly evaluate the periodontal status of patients, it is recommended that probings be done at every professional hygiene appointment. This not only allows the hygienist and doctor to do a more complete evaluation, in order to know what treatment needs to be done at that appointment, but it also places an importance of having not only healthy teeth, but healthy gingiva.

Any time a professional takes the time to do a specific evaluation or test, it creates a greater importance and concern. Even when we go to the medical doctor, if they do an additional test we are immediately more interested in what the results are. Therefore, we as dental professionals need to place the same importance on probing as we would an MRI if we were the patients.

It is also recommended that the probings be done out loud so the patient is able to hear the measurements. However, even before doing the probings it is best to educate the patient about what exactly the probings mean, what you are going to do, and what the results mean to them. Yes, you may have explained what probings are in the past, but until the patient is actually being actively involved with every number called out, more than likely they still do not completely understand what the probings mean.

When explaining the probings to the patient, it is best to call the analysis exactly what it is, probing. Patients need to be educated on our systems and evaluations using the common terminology used in the profession, not what we may call it in our individual offices. This will help them to be able to talk to friends and family members about their individual treatment and know what was or was not done.

Many of you are saying, yes, it would be nice to do the probings out loud but my office does not have the extra team players available to help all the time. There are new computer systems that were designed to help specifically with co-diagnosis, educating the patient, and giving a good print out that the patient can take home and own their disease. When choosing what system works best for your office here are a few things to consider:

  • Educates the patient about periodontal disease.
  • Communicates to the patient what probings are
  • Explains to the patient what the probings mean
  • The probings are said aloud so the patient is able to hear them
  • Indicates aloud and on the charting when there is bleeding and or exudates
  • Capable of printing out a chart that is easy for the patient to understand
  • Can be easily used by multiple providers
  • Is calibrated in order to give continuity between providers

Others are saying we have never probed in the past how do we explain why we are probing now. If you are going to be using the traditional probing system or a computer probing system, explain to the patient, “Jane, there have been many recent advances in research, resulting in the development of new and exciting procedures in dentistry. One of the most beneficial procedures is the screening process called probing that enables us to detect gum disease in the earliest stages. If you have been experiencing stress or your immune system is depressed, the progression of the disease may be affected. It is our commitment to screen all our patients on a regular basis since treatment in the earliest stages is the most successful.”

This sample presentation serves as a framework that the doctor and staff can build on. It is designed so that you may find the conversation that best suits you.

Any time new technology is introduced, such as a computerized probing system, the patient will be the one asking the questions immediately.

The ability to answer patient’s questions with confidence is directly proportional to acceptance of therapy. Practice your response until you are confident in answering. The patient will perceive your confidence and treatment acceptance will increase.

Regardless of what system you use while probing, it is in the best interest of the patient and the practice that the office be committed to screening, treating, and referring out patients with periodontal disease when appropriate.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

Interested in having Jean speak to your dental society or study club Click Here.

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